MAUDE MDR 7738885

MDR report key
7738885
Report number
0001811755-2018-01548
Event key
0
Event type
3
Date of event
2018-06-13
Date received
2018-08-01
Adverse event
3
Product problem
3
Patients in event
0
Reporter occupation
0
Health professional
3
Initial report to FDA
3
Event location
3

Manufacturer Contact#

Contact
MR. ZACH BAKER
Address
4100 EAST MILHAM AVENUE KALAMAZOO MI 49001 US
Phone
269-269-2693
Report source
M
Manufacturer link flag
Y

Devices#

Seq, Brand, Generic table
SeqBrandGenericManufacturerProduct codeModelCatalogLotPMA510(k)ImplantEvaluatedAvailability
1ACM KIT W/ FEMORAL BREAKAWAY NOZZLEMIXER, CEMENT, FOR CLINICAL USESTRYKER INSTRUMENTS-KALAMAZOOJDZ0306563000R N

Patients#

Sequence, Received, Treatment table
SequenceReceivedTreatmentOutcome
12018-08-010

Event Narratives#

D

Patient 1

IT WAS REPORTED THAT A HAIR WAS OBSERVED IN THE PACKAGING. THERE WAS NO ASSOCIATED PROCEDURE AND THEREFORE NO PATIENT INVOLVEMENT.